From the Research
The treatment for severe supraspinatus tendinosis typically begins with conservative measures including rest, activity modification, and physical therapy focusing on rotator cuff strengthening exercises. Anti-inflammatory medications such as ibuprofen (400-800mg three times daily) or naproxen (500mg twice daily) for 1-2 weeks can help manage pain and inflammation, although a study by 1 suggests that ibuprofen may decrease muscle hypertrophy. Physical therapy should be continued for 6-12 weeks, emphasizing eccentric strengthening exercises and scapular stabilization, as supported by a study on the effectiveness of manual therapy in supraspinatus tendinopathy 2. If conservative treatment fails, corticosteroid injections (such as methylprednisolone 40mg mixed with lidocaine) may provide temporary relief, though these are limited to 2-3 injections per year due to potential tendon weakening, with a study by 3 showing no significant difference between glucose prolotherapy and corticosteroid injections. For persistent cases, newer treatments like platelet-rich plasma (PRP) injections may be considered. Surgical intervention, typically arthroscopic debridement or repair, is reserved for cases that fail to respond to 3-6 months of conservative management, as indicated by a review of treatment options for tendinopathy 4. Some key points to consider in treatment include:
- The use of NSAIDs and corticosteroids for short-term pain relief, but their long-term effectiveness is unclear 4
- The potential benefits of eccentric strengthening protocols, sclerotherapy, and nitric oxide patches, although larger studies are needed to confirm these findings 4
- The importance of a comprehensive approach to treatment, given the degenerative changes in the tendon and the complexity of the condition. Overall, the goal of treatment is to reduce pain and inflammation, promote healing, and improve function, with a focus on conservative measures and a gradual progression to more invasive treatments as needed.